The Embedded Self: A Psychoanalytic Guide to Family Therapy (Book Review)

Author:  Gerson, Mary-Joan
Publisher: Hillsdale, NJ: Analytic Press, 1996
Reviewed By: Phyllis Cohen, Fall 2001, pp. 44-45

(This review originally appeared in the Section VIII Newsletter and is reprinted here with permission. Editor)

Question: “What can be simultaneously exhilarating, humbling, and surprising to analysts?” Answer: “The impact of a systemic change on an individual family member.” If this is not enough incentive for an analyst to read a book about family systems theory and therapy, Dr. Mary-Joan Gerson reminds us that we are increasingly asked to see couples and families, or refer individuals to couple and family therapists.

In this book, Gerson argues that analysts should be informed in the language of family therapy and that individual and family clinicians should become familiar with both modalities. Therapists equipped with both a psychoanalytic and a systemic lens may more competently and creatively face clinical dilemmas.

Gerson laments that there are analysts who view significant others as interfering in a patient’s life rather than participating in it; that many a talented, experienced individual therapist does not deal with a core issue in a person’s life simply because he or she “did not have the opportunity to hear about it or witness it.” Many analysts do open their doors to the spouse or partner of a patient. Dr. Gerson cautions, however, that they often “work within a formulation of reciprocal individual dynamics, not overarching systemic patterns.” This use of a single lens greatly limits what can be accomplished.

Every individual is embedded in a social system, and, Dr. Gerson says, family work can enrich individual treatment. How often does a patient describe a significant other quite differently from the person whom the therapist subsequently meets? And how often do people present differently in different relationships?

This book is about comparisons between psychoanalytic and systemic paradigms for the clinician who may be “crossing the divide.” Dr. Gerson takes the reader on a historical journey when she introduces the clinical approaches of four of the founding fathers of family therapy, Bowen, Haley, Minuchin, and Whitaker, and the founding mother, Satir. She suggests that the psychodynamic theorist should gain a working knowledge of these basic perspectives before studying the more modern family therapy approaches, such as the narrative method, that parallel the psychoanalytic paradigm.

Throughout the book, Dr. Gerson demonstrates a remarkable ability to integrate theoretical concepts of systems and psychoanalysis. We see that, despite the many differences in perspective and vocabulary, “there can be a useful interpenetration of ideas from one to the other.” She explains that each perspective “offers a different set of explanations and contrasts.” At the same time she advocates that in clinical work “one gestalt must dominate.” In fact, this is one of Gerson’s major ideas. She suggests that the psychoanalytically-oriented family therapist should hold the psychoanalytic paradigm as figure and the systems model as background position, while the reverse should be true for family therapists.

To illustrate differences between the two paradigms, Dr. Gerson describes a couple who display anger and disrespect for each other. She feels that psychoanalytically-trained therapists might become unbalanced by the couple’s intense negativity. In contrast, a therapist trained in family therapy might identify a pattern in which, say, the wife takes on the role of “manager” and the husband that of “underling.” Having located salient patterns, the therapist would then explore how repeated behavior sequences are maintained by the couple. Dr. Gerson says, “Health from a family systems perspective ultimately resides in an ability to flexibly imagine new configurations of relationships.”

In addition to her discussion of theory, Dr. Gerson includes a chapter on diagnosis, which details how to conduct an initial interview. She also has a chapter on interventions which describes some of the popular techniques used by family therapists, and a chapter on how, when and where to make referrals.

As a child therapist, I found the chapter, “Playfulness, Authoritativeness, and Honesty” interesting and absorbing. Dr. Gerson says that being playful in family therapy offers “a positive, non-threatening way to try out new patterns of relating.” She cautions us about the danger that “analytic playfulness” can be “a disruption of the patient’s unfolding.” Those of us who work psychoanalytically with children are trained to use metaphors and images communicated by our child patients, not the therapist. Those who are trained specifically to work with adults may have a more difficult time transitioning to the playful stance of a family therapist. It would do us all good to be reminded that in the current thinking about mothers and infants, the infant grows emotionally within the context of a playful, mutual relationship. Being playful in analysis or family therapy has a place only when it is initiated by the patient’s freed-up energy. If the therapist takes this position, there is no risk to the analytic frame or to any psycho-therapeutic treatment.

If there is a criticism to be leveled, it is that for a book intended to introduce family systems theory to psychoanalysts, some of the discussions of theoretical controversies may be more detailed than necessary. In addition, more cross-referencing within the book itself could help make many of the concepts clearer.

In sum, The Embedded Self successfully extends the realm of analytic recognition to view the patient from “a wider-angle lens.” Dr. Gerson reminds us that much of what we may view as “pathological individually-lodged symptomatology is both created and maintained in family cultures.” She also says, “The psychoanalytic clinician is enjoined by post-modernism to expand the personal perspective of the patient so that new opportunities for self-organization and relationship are both imagined and experienced. It turns out that to do so, there is really no place like home.”

As in any pluralistic field, in contemporary family psychotherapy there is no unified theory of couple treatment. Integration has become necessary in order for a practitioner to be conceptually and technically proficient, yet to be an integrationist is a complex and difficult task for the clinician. Mary-Joan Gerson’s work provides a significant step towards this goal.

Reviewer Note

Phyllis Cohen is a psychoanalyst in private practice in Brooklyn. She is the Director of the New York Institute for Psychotherapy Training in Infancy, Childhood and Adolescence, and is an adjunct professor at NYU Department of Applied Psychology.

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